Trauma and the Stress Response
Can everyone experience trauma? If so are some more susceptible than others? On the surface these questions are fairly straightforward, yes everyone one can be traumatised and there are a significant number of risk factors that not only make it more likely that you will experience trauma but that also effect your ability to manage it.
Before looking at the effects of trauma it is necessary to have an understanding of what it is, how it effects us and how we typically respond to it. In doing this we can start to see how our experiences can shape our stress response and how this may lead to unwanted anti social behaviours, mental health issues and problems with our physical health. It is important to note that in using the term we or the like, I am referring to people generally and not a group of individuals. I will look at the more specific impact of trauma as I perceive it on autistics later in this post.
Whilst trauma can be caused by a number of different affects, for the purpose of this post I will not look so much at the mechanism of trauma that is to say the event or events that led to a person being traumatised but rather the frequency and form. This means that I will look at trauma as being acute or chronic/complex.
Trauma is defined as a deeply distressing or disturbing experience that can cause physical injury or emotional shock with acute trauma defined as being caused by a single traumatic event that causes extreme emotional or physical stress. Chronic or complex (used from here on) trauma is the result of reoccurring traumatic experiences over time or the build up of traumatic experiences over a lifetime. All forms of trauma can have a profound impact on us and each persons experiences and reactions will be specific to them. In this case I will look at how complex trauma physiologically and emotionally changes how we see and interact with the world.
The effects of trauma have a commonality but there are differences with relation to a persons age at the point of being exposed. If in infancy you have developed a secure attachment, that you then used as a base to explore the world around you, with your needs met at times of distress. Then it is likely that when you are effected by trauma as an adult you will be able to make use of these experiences and the attachments you have developed in your life to work through your difficulties and seek appropriate help. There are a number of situations where one can be so profoundly impacted by an overwhelming event or series of events that our coping mechanisms are not enough, but even here the secure base formed in infancy and through our childhood increase the likelihood of a positive outcome.
For those infants/children that experience complex trauma the effects are profound and life long. Whilst it is now known that it is possible to significantly reverse the damage, enough for a person to develop in to a functioning and emotionally capable adult. The long term impact is to reduce the persons ability to manage stress, negotiate relationships and regulate there bodies to maintain an emotional and physiological equilibrium leading to any number of issues in later life. In order to help the child reach their potential requires appropriate support and often intensive work with the child.
The work with the child is necessary as trauma does not only have an emotional element, we know that trauma has a profound effected on the development of a child’s brain leading to a number of difficulties, including but not limited to:
- Behavioural difficulties
- Attachment disorders
- Mental health issues
- Cognitive delays
- Physical and emotional developmental delay
- Medical complaints
- Inappropriate responses to risk
- Sensory processing and integration difficulties
As we develop through infancy and into childhood our brains create neural connections, the vast majority of these are created before we turn two. From this point on our brains start to prune connections that are not used while it strengthens and builds on those that are. The more frequently we use a connection the stronger it gets. These connections are also sequential in their nature. This means that they build on each other much like you build the foundations of a building first before building up. When someone is put under stress the brain triggers a fight, flight, freeze/disassociate response, releasing cortisol from the adrenal gland as part of general adaptation syndrome. The cortisol is designed to help us prepare for fight or flight and if we are unable to do this the cortisol levels build up in the blood causing harm.
If we experience complex trauma then the body needs to release increasing levels of cortisol to have the same effect. It also reduces the amount of serotonin (happiness hormone) further compounding the impact of the negative events. The cortisol has a catastrophic impact on an infants developing brain damaging neural connections and preventing their development. This leads to developmental trauma disorder (Bessel A. van der Kolk) and often an attachment Disorder as the child does not have an experience of having their needs consistently meet and establishing a secure base.
As the child develops with significant gaps in there foundations and the building blocks of development, they do not have the stable base upon which they can build skills, such as communication, executive function and risk management. This makes the world is an increasingly hostile place and without the attachments or skills necessary to develop attachments there is no secure base (safe place) to return to when they are distressed. Often all that is available to them is a care giver that is inconsistent or absent, hostile and rejecting of the child’s needs. This can lead to the child spending increasing quantities of time in their stress response, limiting cognitive, emotional and physical development.
If we think about the brain having there areas we can look at what happens when we experience trauma and the stress response is triggered. The initial response is for the brain to shift into the reptilian (survival) part of our brain, its purpose is largely to manage unconscious processes that keep us alive, breathing, blood flow etc. It also operates the fight, flight response. Shortening neural pathways and speeding our responses, you don’t need to be able to have a conversation if your running away from a wild animal or if you’re pummelling it to death to save yourself.
After we experience the initial triggering of the stress response our reptilian brain checks in with the mid brain, responsible for things like memory and emotions. At this point when everything is working as it should the mid brain goes either yep that’s a lion we need to run away or it will kill us or it’s just a fake like lion it doesn’t look right. If the later were to happen then your mid brain connects the initial response with your cortex, the part of your brain responsible for cognitive processing and you are able to reason and rationally evaluate the situation. Helping your body to calm. If things do not work properly then even though there is not threat your system is geared to responded as if there is. The repeated incidents of trauma mean that massive amounts of cortisol are needed to effectively prepare for and responded to threats. The mid brain has a memory bank full of traumatic experiences, anything it doesn’t understand or that has triggered the stress response is seen has a threat shifting straight back into the fight, flight response.
This leads us to the third part of the fight, flight response. If for what ever reason you are unable to run away or fight off the source of your trauma e.g. being a child suffering sexual abuse. Then you will shift into disassociating, shutting your brain off from the external reality. This however is an adaptation of the stress response not a process of shifting out of the response. Your body is still building up cortisol in the blood but there is no physical response. What does work at these times is your sensory system, it is hyper-vigilante to the environment and everything in it. Traumatised children are often able to hear, smell and observe things that others cannot. As it is the sensory system that takes in most of the information during traumatic experiences, it is often sensory input that triggers the stress response. Those who are traumatised are also highly attuned to stress responses in others and can be triggered by even small or usually unnoticeable signs of stress or anxiety.
This leads to the question of how you calm someone in this state if you cannot reach them cognitively and the memories and emotions identify you as a threat. There are lots of different approaches to this that have varying rates of success. In my view the best approach in its simplest form could be described as regulation, relationships and reasoning.
Makes use of the primary senses that the person in their reptilian brain is using to assess and respond to the world around them. Through making use of sensory inputs often physical (proprioceptive, a physical sense of where we are) but also others, primarily touch and vestibular (our sense of orientation). By recognising the sensory needs in the person you can guide actions towards meeting those needs. This sensory input regulates the brain, calming it down and moving it back into it’s “normal” state.
These are the key to the process, the child (person) will default to there primary experiences and attempt to bring their current experiences in line with those that are familiar. The unknown is much more scary than the known, even if that known is traumatic. The child will seek to act out (reenact) the trauma in order to try and make sense of it, however without additional support or guidance they are likely to only succeed in recreating past relationships and continuing the cycle of trauma. In developing secure and trusting relationships it is possible to start to rewrite the narrative experience and to provide options other than fight, flight or disassociate. This is one of those things that is nowhere near as easy as it sounds.
This is the part of the process where you help the child to think about and understand the narrative of there difficulties and life experiences. In many ways it involves working through there experience and helping them to recognise and assign emotions and feelings. To gain a greater awareness of their physiological and emotional state and how the world and others impact them. Helping them to develop the tools necessary to work through this process independently or to recognise times when they need help and to be able to seek it appropriately.
The Addition of ASD
So what has this got to do with Autism and the autistic experience? Well let me start this section by saying that everything covered so far is fairly well established theory if quite significantly simplified. I am now going to wade into some fairly murky waters, filled with my opinions, interpretations and theories. Whilst I am not wholly unqualified to put forward these views it is worth noting that there is little research into the direct links between ASD, Developmental Trauma Disorder and Attachment Disorder. The bulk of the research is aimed at differentiating between them. This led me to ask is it possible for an autistic person to have an attachment disorder and/or development trauma disorder.
It seems quite clear that many of the behaviours associated with all three can present in very similar ways with nuanced differences, that are not easily separated even by those with years of experience. I would suggested that autistic people have a significant risk of developing attachment issues and developmental delays due to having relationships with care givers that do not meet their needs and through repeated traumatic experiences, that come from being overwhelmed by the world around them and not being able to express their needs in a way that would ensure they are recognised and meet.
This is by no means straight forward as I am not suggesting that parents of autistic are in anyway reasonable for the difficulties their children face. In fact I strongly believe that as a general rule parents do everything they can to reduce or eradicate traumatic experiences for their children. This for me is the element that should be looked for when seeking to work out which aspects of a persons difficulties are related to what. That said when a child is born they are wholly dependent on their care givers to meet all of their needs, they cannot survive on their own and they are unabl to differentiate the level of importance in relation to each need. To a baby need is need, it’s all life and death.
So if a baby is autistic and accepting that they are autistic from birth with associated autistic experiences, then I would suggest that it is likely they have a unique set of needs that would not be instinctively or obviously met. This would mean that the child’s experience under good enough conditions would be that of having those needs it shares with a neurotypical child met and those that are unique to them as an autist being inconsistently met. I would go on to suggest that this could signify a specific attachment pattern attributable to the autistic community if parenting is not sufficiently adaptive. I would refer to this as an Insecure Autistic Attachment (IAA).
When looking at how the neurotypical brain responds to complex trauma it may be reasonable to infer that complex trauma driven by an Insecure autistic attachment and inherent difficulties in tolerating sensory in put, communicating with others (including developing reciprocal relationships) and the sense of isolation that comes from being different, would lead to varying degrees of developmental trauma disorder, mental health issues and other social and behavioural difficulties. It is therefor necessary that treatment support programmes not seek to work with these areas separately but see them as a whole, providing all autistic children with support structures that are aimed at long term mental health through regulation, relationships and reasoning.
It would appear that a significant number of autistic adults suffer with mental health issues and more commonly a sense of getting things wrong and being to blame for this. This is likely to be a contributing factor in a recent study that showed life expectancy for autistics is significantly less than that of their neurotypical counterparts. In my opinion it is time that we stopped attributing mental health issues, anxiety and low self esteem/worth to solely to our experiences with the world around us in the here and now. There would appear to be a need for society and the autistic community to start addressing the impact of complex trauma and insecure autistic attachment. Identifying children with a higher risk of being autistic and supporting parents to recognise and work with a different set of primary needs. In today’s more sedentary digital age children an adults need to be thought to recognise what their bodies are communicating and given the skills to regulate themselves. The separation of autism from the impact of trauma and attachment disorders feeds in to the historical narrative and stereo type of autistics being emotionless and unable to form attachments or reciprocal relationships.
Autism does not in my view simplify the neurological make up of an individual or lessen the impact of emotion and feelings led experiences. Rather it adds an extra layer to the web of neurological pathways. We have to find a way of working with the whole and stop trying to understand it by breaking it down to it’s constituent parts.
Aspie and Proud